Honey in Alleviating Severe Oral Mucositis Among Head and Neck Cancer Patients Undergoing Radiation Therapy.

BACKGROUND/AIM: Aiming to resolve debates on honey's efficacy for radiotherapy-induced severe oral mucositis in head and neck cancer, we conducted a meta-analysis focused on randomized trials, primarily assessing severe mucositis incidence. Secondary outcomes included weight loss, pain management, and honey types. MATERIALS AND METHODS: A comprehensive literature search was conducted in PubMed, Embase, WOS, and the Cochrane Library up to December 2023. The analysis concentrated on randomized controlled trials that assessed the efficacy of honey, targeting the incidence of mucositis as the main outcome. Additional outcomes explored were weight loss, intolerable pain, and the specific types of honey used in interventions. Data analysis was performed using CMA software, and a funnel plot was employed to identify publication bias. RESULTS: The analysis of 176 records resulted in the inclusion of 10 studies with 599 patients receiving radiotherapy. The research showed that honey significantly reduced the occurrence of grade 3-4 mucositis (severe mucositis), provided significant pain relief, and had a positive effect on reducing weight loss. Regarding the type of honey used, no significant differences were found in their effectiveness in alleviating severe mucositis. CONCLUSION: Honey serves as an effective intervention for individuals with oral mucositis. It can be considered as an adjuvant in the management of clinical radiotherapy-associated oral mucositis, particularly for patients requiring prolonged use of anti-analgesic or antifungal medications.

Nonmedical prescription drug use of analgesics and sedatives/hypnotics in Taiwan: Results from the 2014 National Survey of Substance Use.

Nonmedical prescription drug use (NMPDU) has become a major public health issue but little is known in Asian populations. This study aimed to investigate the prevalence and correlates of NMPDU in Taiwan. Participants from the 2014 national survey of 17,837 individuals, aged 12 to 64 year, completed anonymously a computer-assisted self-interview. Past-year prescription drug use was divided into medical use only (MUO) and nonmedical use (NMU), defined as using the drug without a prescription, or more frequently, or in larger doses than prescribed. Problematic alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT), problematic drug use using the 20-item Drug Abuse Screening Test (DAST), and depressive symptoms using the Center for Epidemiological Study-Depression (CES-D). The prevalence of past-year NMU was 3.02% for analgesics, 0.71% for sedatives/hypnotics, and 3.66% for either drug, with a very small overlap of NMU between analgesics and sedatives/hypnotics (0.07%). When individuals with NMU were compared to those without NMU (Non-NMU) and those with MUO, respectively, some correlates consistently identified, including young adulthood, tobacco smoking, alcohol drinking, and greater AUDIT's scores for analgesics, as well as hard drug use and greater DAST's scores for sedatives/hypnotics. NMU was associated with greater CES-D's scores for both analgesics and sedatives/hypnotics when compared to Non-NMU but not to MUO. Robust correlates of NMPDU could offer implications for development of prevention strategies of NMPDU.

E-Cigarette Use in a Country With Prevalent Tobacco Smoking: A Population-Based Study in Taiwan.

BACKGROUND: The different profiles of e-cigarette users in different age groups have seldom been investigated, particularly in populations facing a high prevalence of cigarette smoking. This study aims to examine the prevalence and correlates of e-cigarette use separately for adolescents and adults in nationally representative samples in Taiwan. METHODS: Among 17,837 participants in the 2014 National Survey of Substance Use in Taiwan, 4445 were aged 12 to 17 years and 13,392 were aged 18 to 64 years. Individuals' lifetime tobacco use was divided into four groups: non-use, exclusive e-cigarette use, exclusive cigarette use, and dual use. Questions on sociodemographic features, use and problematic use of tobacco, alcohol, and other drugs, and psychosocial distress, among others, were administered using a computer-assisted self-interview on tablet computers. RESULTS: Among lifetime users of e-cigarette (2.2% for adults and 0.8% for adolescents), 4.5% for adults and 36.6% for adolescents were exclusive e-cigarette users. From use of exclusive e-cigarettes to use of exclusive cigarettes to dual use, those usage groups were related to an increasing trend of adjusted odds ratios for use of other psychoactive substances, particularly problematic use of alcohol or drugs, and with more depressive symptoms. Two correlates were specific to e-cigarette use: alcohol use had stronger relationships with e-cigarette use among adolescents, and younger adults (18-34) were more likely to try e-cigarettes compared to older adults. CONCLUSIONS: These results provide essential information regarding e-cigarette use in the general population, and future prevention strategies should account for its specific correlates in young people.

Human papillomavirus prevalence and behavioral risk factors among HIV-infected and HIV-uninfected men who have sex with men in Taiwan.

Human papillomavirus (HPV) infection is associated with cancer and can be prevented through vaccination. Few studies from Taiwan have reported on HPV infection among human immunodeficiency virus (HIV)-infected subjects. The aim of this study was to examine the prevalence of HPV infection among men who have sex with men (MSM) with and without HIV infection in Taiwan, and explore the behavioral risk factors thereof.We conducted a cross-sectional study in Taiwan during 2013 to 2016 to collect data on MSM aged 20 years or older. We used a questionnaire in a face-to-face interview, and subsequently collected oral, anal, and genital specimens from HIV-infected and HIV-uninfected subjects. Multivariate analysis was performed to predict factors associated with high-risk HPV (HR-HPV) positivity.Overall, 279 subjects, including 166 (59.5%) HIV-uninfected and 113 (40.5%) HIV-infected men were enrolled. Compared to HPV-negative subjects, HPV-positive subjects had significantly higher rates of receptive anal sex (91.3% vs 75.6%), substance use (22.6% vs 11%), history of sexually transmitted infections (75.7% vs 38.4%), anogenital or oral warts (39.1% vs 6.72%), syphilis (32.2% vs 11.6%), and HIV infection (69.6% vs 20.1%). We detected 489 HPV deoxyribonucleic acid (DNA) types (through 379 viable specimens), of which 43.6%, 5.7%, 56.4%, and 10.4% were HR-HPV type, HPV type 16, low-risk HPV types, and HPV type 6, respectively. In multivariate analysis, HIV-infected subjects had a significantly higher prevalence of HR-HPV infection (adjusted odds ratio, 5.80; 95% confidence interval, 2.57-13.11), compared to HIV-uninfected subjects.These results suggest that the prevalence of HPV infection was high among HIV-infected MSM. Additionally, anal HPV infection was observed to be common among both HIV-infected and HIV-uninfected MSM in Taiwan. The prevalence of oral and genital HPV infection, HR-HPV DNA types, and multiple HPV types was higher in HIV-infected subjects than in HIV-uninfected subjects. As only 35% of subjects practiced safe sex, we recommend routine HPV vaccination with 4-valent HPV or 9-valent HPV vaccines for both MSM, and HIV-infected subjects.

Children are particularly vulnerable to environmental tobacco smoke exposure: Evidence from biomarkers of tobacco-specific nitrosamines, and oxidative stress.

BACKGROUND: Worldwide, smoking is a major public health problem, with exposure to environmental tobacco smoke (ETS) affecting both smokers, and passive smokers, including children. Despite ETS also describing secondhand, and thirdhand smoke (SHS, and THS respectively), the health effects of exposure to passive smoking via these sources are not fully understood, particularly in children. Although cotinine, the primary proximate metabolite of nicotine, has been widely used as a biomarker of ETS exposure, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), the metabolite of the tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), provides a uniquely important contribution, both as a biomarker of exposure, and as a specific risk indicator for pulmonary carcinogenesis. METHODS: We used LC-MS/MS to study NNK metabolites, cotinine, and 8-oxo-7,8-dihydro-2'-deoxyguanosine (a biomarker of oxidative stress), in the urine of 110 non-smoking adults (age range: 23-62) and 101 children (age range: 9-11), exposed to ETS. RESULTS: In our study of passive smoking adults, and children exposed to ETS, we showed that although the children had a similar urinary level of cotinine compared to the adults, the children had approximately two times higher levels of urinary total NNAL (P = 0.002), and free NNAL (P = 0.01), than adults. The children also had three times lower ability to detoxify NNK than adults (P < 0.001). Furthermore, the children showed 1.5 times higher ratio of total NNAL/cotinine than adults (P = 0.01), implying that THS is another important source of ETS in this population. Furthermore, ETS exposure in children appeared to lead to an increase in levels of oxidative stress. CONCLUSIONS: Taken together, our results demonstrate that, in children, THS may play an important role in the ETS exposure, and that children are at particular risk of ETS-induced health effects.

Differences in prevalence, socio-behavioral correlates, and psychosocial distress between club drug and hard drug use in Taiwan: Results from the 2014 National Survey of Substance Use.

BACKGROUND: This study examined variation between users of 'club' and 'hard' drugs in Taiwan in terms of prevalence of use and demographics and psychosocial characteristics. METHODS: Data were derived from a survey of 17,837 Taiwanese civilians, aged 12-64 years, using stratified, multi-stage, random sampling. Participants completed a computer-assisted self-interview on tablet computers which covered use of legal substances, sedatives/hypnotics and prescription analgesics; use of illicit drugs/inhalants, risky sexual experiences; expectations of drugs; and psychological distress. FINDINGS: Approximately 1.29% of respondents reported ever using an illicit drug in their lifetime; prevalence estimates of club drugs (mainly ketamine, marijuana, and ecstasy) were slightly higher than hard drugs (mainly methamphetamine and heroin). Concurrent use of legal substances, particularly problematic use of alcohol and tobacco, as well as non-medical use of prescription drugs, were strong correlates of illicit drug use in general, with club drug use exhibiting an extremely strong association with alcohol use. Club drug users were demographically different from hard drug users, including in terms of their gender, age, and level of educational attainment. They were also more likely to be divorced or widowed, to report risky sexual partnerships and more depressive symptoms than hard drug users. CONCLUSIONS: Our findings indicate drug type specific distinct psychosocial characteristics, which may warrant further attention in the design of treatment and intervention programs.

Risky Sexual Behaviors as Correlates of Depression and Suicidal Ideation Among Male HIV Test-Seekers at a Voluntary Counseling and Testing Facility in Taiwan.

This study aims at determining the level of depression and suicidal status of adult HIV test-seekers. Of the total enrolled 850 males, almost 50% reported some risk behaviors, 38.9% experienced depression, and 7.2% had suicidal ideation. Subjects with risky sexual behaviors in terms of repeated HIV test, had a history of sexually transmitted disease, engaged in one-night stands, or did not use condoms all the time with causal sexual partners were more likely to have depression. Furthermore, subjects who were bisexual/homosexual, engaged in Internet sex, engaged in one-night stands, or used addictive drugs within the past 6 months were more likely to experience suicidal ideation. The HIV testers are at risk of experiencing depression and suicidal ideation; each is associated with different types of risky sexual behaviors. It is essential for the health authority to further provide mental health services for HIV testers and to draw up an effective strategy in reducing unprotected sexual behaviors.

Sleep-disordered breathing, behavior, and academic performance in Taiwan schoolchildren.

OBJECTIVE: The behaviors of children may be affected by sleep-disordered breathing (SDB). This study adopts a cross-sectional approach to investigate the relationship between the sleep apneas-hypopneas index during sleep and the behavioral and academic performance of schoolchildren in Taiwan. METHODS: A total of 138 children (85 boys and 53 girls), ages 6-11, were recruited from two elementary schools to participate in this study. Overnight polysomnographic examinations in hospital were performed to assess sleep quality, including total sleep time, arousal index, apneas-hypopneas index, desaturation index, and lowest oxygen saturation, as well as the percentage of total sleep time spent in rapid eye movement, stage 1, stage 2, stage 3, and stage 4. The children's parents and teachers were required to complete a Chinese version of the Child Behavior Checklist and Teacher's Report Form to assess child behavior and academic achievement. RESULTS: Compared with children without SDB (apneas-hypopneas index ≤1), those with severe SDB (apneas-hypopneas index >15) exhibited more irregular behavioral performance in somatic complaints (odds ratio (OR) = 9.43; 95% confidence interval (CI) = 1.04-85.71) and attention (OR = 9.95; 95% CI = 1.02-97.00). However, different severities of SDB groups did not show significant associations in academic performance. CONCLUSION: Our study suggests that children with severe SDB may predispose to somatic complaints and attention problems so that sleep examination or medical intervention might be provided at an early age in these children.

Effects of diesel vehicle emissions of polycyclic aromatic hydrocarbons on the surrounding environment and residents.

Ten stations alongside major thoroughfares were selected as exposure sites, while a small village located about 3 kilometers away from a main traffic route was selected as the control site. The concentrations of particulate matters with aerodynamic less than 2.5 microm (PM(2.5)) and elemental carbon (EC) at exposure sites were both higher than those at the control site. Daytime mean concentrations of total polycyclic aromatic hydrocarbons (t-PAHs), carcinogenic PAHs (car-PAHs), and Benzo(a)pyrene-equivalent dose (BaP(eq)) at exposure sites were all about twice as high as those at the control site. A significant relationship between t-PAHs and EC was found, suggesting that most of the t-PAHs at exposure sites were contributed by diesel exhaust. Furthermore, the diagnostic ratios also show that diesel emissions were the dominant sources of PAHs at exposure sites. A multiple linear regression was applied to urinary 1-hydroxyprene (1-OHP) using four variables (exposure status, sex, smoker status, and incense burning) as independent variables. The results showed that the concentrations of 1-OHP in exposure groups were significantly (p < 0.001) higher than those in the control group. The explainable percentage for exposure status was 91.1%, indicating that the exposure factor, in comparison with other factors, has a dominant contribution to the concentration of 1-OHP. After subtracting the background levels of 1-OHP, the levels of urinary 1-OHP for residents exposed to the exhaust of 100 vehicles were about 0.062 microg/g creatinine.

Repeated measurements of urinary methylated/oxidative DNA lesions, acute toxicity, and mutagenicity in coke oven workers.

We conducted a repeated-measures cohort study of coke oven workers to evaluate the relationships between the traditional exposure biomarker, urinary 1-hydroxypyrene (1-OHP), and a series of biomarkers, including urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), N7-methylguanine (N7-MeG), acute toxicity, and mutagenicity. A total of eight spot urine samples were collected from each high-exposed (at topside oven area) and low-exposed workers (at side oven area) during the whole working cycle, which consisted of 6 consecutive days of working followed by 2 days off. Our results showed that the high-exposed workers had significantly higher urinary levels of 1-OHP, 8-oxodG, and N7-MeG compared with the low-exposed workers. Acute toxicity and mutagenicity of urine were also found to be markedly increased in the high-exposed workers, as determined by Microtox assay and Ames test, respectively. Multivariate regressions analysis revealed that the urinary 8-oxodG, N7-MeG, or acute toxicity was significantly correlated with 1-OHP concentrations. Overall, the present study showed that exposure to coke oven emissions increased oxidatively damaged DNA products and mutagenicity of urine, and for the very first time, such exposure was also found to increase DNA methylation and urinary acute toxicity. The potential source of methylating agents in coke oven emissions warrants further investigation. Additionally, with repeated measurements, the pattern of time course for urinary 1-OHP was found to be different from those of 8-oxodG and N7-MeG, as well as acute toxicity and mutagenicity. This finding implies that the single measurement that was often conducted in occupational healthy investigations should be used with certain precautions, because single measurement may fail to provide the proper information of interest.

A comparison of elementary schoolchildren's exposure to arsenic and lead.

One hundred fifty seven fifth-grade students (aged 10-12 years) from three elementary schools in three different towns in Taichung County, Taiwan were chosen as study subjects for the present arsenic and lead exposure study. The three towns--Longgang, Shalach, and Shuntain--are known to be highly, moderately, and lightly (control) polluted by As and Pb, respectively. Spot morning urine samples of students were collected and analyzed for arsenic and lead. The levels of As in the urine of Longgang schoolchildren showed the highest value among the three schools, while those of the control group (Shuntain) had the lowest values. In addition, the levels of Pb in the urine of the schoolchildren in Shuntain were significantly lower than those in Longgang and Shalach, while the levels of Pb in the urine of the schoolchildren in Longgang and Shalach showed no significant difference. Results of daily intake of metals from the different exposure pathways (i.e., ingestion from drinking water, household dust and food, and inhalation from airborne particles) showed that the Longgang area had the highest daily intake of As and Pb among the three areas, while the lowest daily intake of As and Pb occurred in the control area (Shuntain). A significant correlation between the doses of daily intake and urinary concentrations of As (p = 0.002) and Pb (p = 0.020) was observed. This correlation suggests that the increase of unit dose of the daily intake for As resulted in an increase of 0.953 microg g(-1) creatinine of As, whereas the increase of unit dose of the daily intake for Pb led to an increase of 0.053 microg g(-1) creatinine of Pb. These data indicate that the level of As in urine increased about 18 times higher than that of Pb for the same amount of increase in daily intake.

Substance use among adolescents in Taiwan: associated personality traits, incompetence, and behavioral/emotional problems.

BACKGROUND: Despite that adolescent substance use is increasingly prevalent throughout the world and leads to increased risk of progression to illicit drug use, few studies have examined in detail individual features that are associated with such use. We aimed to examine personality traits, incompetence, and behavioral/emotional problems in relation to adolescent substance use and possible interactions between these factors. METHODS: Junior high school adolescents (N = 905) randomly selected from Taipei in 1996 completed a questionnaire consisting of substance use experience, the Junior Eysenck Personality Questionnaire (JEPQ), and the Tridimensional Personality Questionnaire (TPQ). Students' parents (N = 854) were asked to complete the Child Behavior Checklist. Logistic regression was used to assess the relationship between substance use and personality traits or behavioral problems. RESULTS: The most commonly used substance was liquid substance (alcohol and refreshing beverage), followed by tobacco and betel nut with an age-related trend in boys. Associated factors of substance use included higher Extroversion and lower Lie Scale (as measured in the JEPQ), higher Novelty Seeking (as measured in the TPQ), poorer School Competence, and more Delinquent Behavior, Aggressive Behavior, and Somatic Complaints. The associations remained unchanged with potential confounders controlled for. CONCLUSIONS: Adolescents who use substance have specific individual features that are readily assessable by existing instruments. This bears important implications for the early intervention of substance abuse in adolescents.